Philippine Journal of Science

148 (1): 7-20, March 2019

ISSN 0031 - 7683
Date Received: 30 May 2018

Factors Associated with Overweight and Obesity

among Adults 20.0 Years and Over: Results from
the 2013 National Nutrition Survey, Philippines

Charmaine A. Duante1*, Jay Lord Q. Canag1, Chona F. Patalen1,

Rovea Ernazelle G. Austria1, and Cecilia Cristina S. Acuin2

1Nutritional Assessmentand Monitoring Division, Department of Science and Technology

Food and Nutrition Research Institute, Taguig City, Metro Manila 1631 Philippines
2International Rice Research Institute (IRRI),

University of the Philippines Los Baños, Laguna 4031 Philippines

In 2016, the World Health Organization (WHO) estimated that at least 2.8 million people die each year
as a result of overweight/ obesity associated with the occurrence of chronic diseases that has dire social
and economic consequences. In the Philippines, the prevalence of overweight/ obesity among adults
showed a gradually increasing trend. Local studies using national-scale data on the determinants of
overweight/ obesity among adults in the Philippines are found to be lacking as related studies available
were done on selected population groups only. This study aimed to address this research gap and provide
evidence for setting goals and targets to halt the increase of overweight/ obesity. Analysis of secondary
data was done using the 2013 National Nutrition Survey results. Findings revealed that 30.0% of 9,076
adults 20.0 years and over with complete socio-demographic, socio-economic, anthropometric, clinical,
and health and dietary data were overweight/ obese. Controlling for the effects of other variables, the
factors significantly associated with overweight/ obesity among adults 20.0 years and over included
adequacy of recommended energy intake, type of residence, age group, civil status, wealth quintile,
highest educational attainment, and smoking status. The odds of being overweight/ obese was 29%
higher among those who met the recommended energy intake compared to those who did not, and 28%
higher among those living in urban areas than rural areas. As socio-economic status improved and as
the population aged, the odds of overweight/ obesity increased. Adults with partners were more likely
to be overweight/ obese than those who were single. In comparison to adults with no grade completed,
the odds of being overweight/ obese were higher among those who were high school/ vocational
graduates and twice as high among college graduates. This study provides consistent evidence on the
factors associated with overweight/ obesity, which may be addressed through multi-sectoral approach
by crafting maximally effective programs and local policies.

Keywords: NCDs, NNS, obesity, overweight, Philippines, risk factors

INTRODUCTION communicable diseases (NCDs). More than 41 million

Lifestyle-related behaviors such as tobacco use, physical
inactivity, harmful use of alcohol, and unhealthy
diets all increase the risk of mortality caused by non-
*Corresponding author:caduante@yahoo.com
people are killed each year by NCDs, equivalent to 71%
of deaths globally. Over 85% of these NCD deaths occur
in low- and middle-income countries (WHO 2018a).
Cardiovascular diseases (CVDs) rank first, followed by
cancer, respiratory diseases, and diabetes. In the Western
Pacific Region (WPRO), NCDs are the leading causes of

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Philippine Journal of Science
Vol. 148 No. 1, March 2019
death and disability – accounting for 80% of all deaths
(WHO-WPRO 2013). The risk factors are modifiable and
driven by forces that include ageing, rapid, unplanned
urbanization, and globalization of unhealthy lifestyles – all
of which may lead to four key metabolic or physiological
changes that increase NCD-risk: raised blood pressure,
overweight/ obesity, hyperglycemia, and hyperlipidemia.
Overweight and obesity are major risk factors for a number
of chronic diseases. In the past, these are considered
problems of affluent countries; however, data shows that
it has steadily affected low- and middle- income countries
(WHO 2018b) that are now facing the double burden of
malnutrition – battling both undernutrition and overnutrition.
According to the Global Health Observatory (GHO) data,
at least 2.8 million people die each year as a result of being
overweight/ obese. An estimated 2.3% or 35 million people
of global disability-adjusted life years (DALYs) are caused
by overweight and obesity (WHO 2016b).
The most recent global estimates by the World Health
Organization (WHO) show that in 2016, at least 1.9 billion
or 39% of adults 18.0 years and over were overweight
– of which 650 million were obese. Globally, 13% of
adult population were obese. The prevalence of obesity
worldwide nearly tripled in a span of 41 years – from 1975
to 2016 (WHO 2018b).
In the Philippines, the prevalence of overweight/ obesity
among adults showed a gradually increasing trend from
16.6% in 1993 to 31.1% for both 2013 and 2015, in
contrast with the generally decreasing trend of chronic
energy deficiency/ underweight in the same age group
(Figure 1) (DOST-FNRI 2015a). The Asia Roundtable on
Food Innovation for Improved Nutrition (ARoFIIN) – a
public-private partnership – reported an overweight and
obesity prevalence of 23.6% and 5.1%, respectively in 2016
(Manila Standard 2017). The report – entitled “Tackling
obesity in ASEAN: Prevalence impact and guidance on
Figure 1. Trends in the prevalence of malnutrition among adults, 20.0 years and over: Philippines, 1993–2013
(Reference: Philippine Nutrition Facts and Figures 2013: 8th National Nutrition Survey Anthropometry).
8
Duante et al.: Factors Associated with Overweight
and Obesity among Adults: 2013 NNS
interventions” – presents results on six (6) countries: the
Philippines, Indonesia, Malaysia, Singapore, Thailand, and
Vietnam. The report findings showed that the Philippines
had the second-lowest overweight and obesity prevalence,
affecting 18 million Filipinos. If monetized, obesity costed
the Philippines around USD 500 million – 1 billion and 8%
of its health care spending – making the country fourth-
highest spender for conditions related to obesity that include
NCDs such as diabetes, cancer, and CVDs (Tacio 2017).
Based on the Global Status Report on NCDs by the WHO
(2014b), the age-standardized prevalence of overweight
and obesity among individuals 18 years and over in the
Philippines is 21.5% and 4.1%, respectively in 2010 and
23.6% and 5.1%, respectively in 2014.
The basic drivers of overweight and obesity are
multifactorial and complex. Thus, it is not enough to
formulate interventions that target individual behavioral
changes only, but rather also address the built environment
where the individual exists that influence physical activity
and dietary behaviors. At present, existing policies and
programs in the Philippines tend to address the NCD
risk factors as a whole, which include unhealthy diet and
physical inactivity. The WHO (2014b) reports that the
Philippines has a national systems response to NCDs in
the form of an operational policy, strategy, or action plan
to reduce physical inactivity and/or promote physical
activity – as well as to reduce unhealthy diet and/or
promote healthy diets to mitigate the main risk factors
for overweight and obesity. According to the WHO NCD
Progress Monitor index (WHO 2017), the country has no
existing policies for salt/ sodium and saturated fatty acids/
trans-fats and no existing restrictions for marketing of
unhealthy food products to children.
Settings-based approaches to promote healthy lifestyle are
implemented through the conduct of weekly dance activities
– in compliance with the Civil Service Commission (CSC)
Philippine Journal of Science
Vol. 148 No. 1, March 2019
Memorandum Circular No. 38, s 1992 or “Physical and
Mental Fitness Program for Government Personnel”
in government workplaces – and a dance activity in
schools after flag ceremony, initiated by the Department
of Health. The most recent legislative undertaking aimed
to help address the problem of overweight and obesity is
the legislation of taxation on sugar-sweetened beverages
(SSB) as part of the first package of the Comprehensive Tax
Reform Program (CTRP) or TRAIN Law (DOF).
As an emerging public health problem, the drivers of
overweight and obesity need to be addressed using a
multi-sectoral approach because of its multifaceted and
complex nature. Local studies using national-scale data
on the determinants of overweight/ obesity among adults
in the Philippines are found to be lacking, as related
studies available were done on selected population groups
(Goyena et al. 2017, Adair 2012) and done in other
countries (Gupta et al. 2012, Mihardja and Soetrisno 2012,
Ghorbani et al. 2015, Little et al. 2016). The identification
of the factors of overweight/ obesity among adults is
warranted to aid in the formulation of nutrition and health
policies and interventions that are maximally effective.
This study aimed to address this research gap and provide
for an evidence-based approach for setting goals and targets
to halt the increase of the prevalence of overweight/ obesity
in the country and attain the WHO Global NCD Targets of
2025 (WHO 2017) and assist in the attainment of health
target 3.4 for Sustainable Development Goal # 3, which is
the reduction by one-third of premature mortality from NCDs
through prevention and treatment and promotion of mental
health and well-being (WHO 2018a). It may also be used as
a basis for a legislation-based promotion of healthy lifestyle
that includes physical activity and a healthful, balanced diet.
MATERIALS AND METHODS
Study Design and Sampling Design
Secondary analysis utilizing data collected in the 8th NNS
conducted by the Food and Nutrition Research Institute
(FNRI) in 2013 was done. The 8th NNS adopted the 2003
Master Sample of the Philippine Statistics Authority
(PSA), employing a stratified three-stage sampling design.
The first stage is the selection of Primary Sampling Units
(PSUs) consisting of one barangay or a combination of
contiguous barangays with at least 500 households each.
Enumeration areas (EAs) with 150–200 households were
identified from these PSUs, from which housing units
were randomly selected. The household is the sampling
unit, which was randomly selected. Further details on the
survey and sampling design of the 8th NNS is published
elsewhere (DOST-FNRI 2015b).
Duante et al.: Factors Associated with Overweight
and Obesity among Adults: 2013 NNS
Selection of Variables
The variables used in this study was based on the conceptual
framework of malnutrition by the ASEAN/UNICEF/WHO
(2016) Regional Report on Nutrition Security in ASEAN
Volume 2 (ASEAN-UNICEF-WHO 2016) and other
previous studies (Back et al. 2018, Rodríguez-Martín et
al. 2009, Trinh et al. 2009, Wang et al. 2016, Rachmi
et al. 2017). Employment, socio-economic status, and
educational status are the basic causes at the societal level.
Underlying causes at the household/ family level include
food insecurity plus poor water and sanitation practices.
Immediate causes include physical inactivity and poor
dietary intake in both quality and quantity.
Data on the socio-demographic and socio-economic
profile of the respondents and selected behavioral and
lifestyle factors were gathered through face-to-face
interview using an interview guide. Anthropometric data
was collected by actual weight and height measurement
of respondents, using standard techniques and procedures.
Data on individual dietary intake was collected using 24-h
food recall for two (2) non-consecutive days.
Socio-demographic and socio-economic profile include
sex, age group, civil status, highest educational attainment,
occupation, type of residence, and wealth quintile. Sex
was categorized into male and female. Occupation was
categorized into 10 major groups based on the 1992
Philippines Standard Occupation Code (PSOC) (PSA).
Type of residence was categorized into two (2) using the
Philippine Standard Geographic Code as reference (PSA).
Wealth index served as the proxy indicator for wealth
status of households derived using data collected from the
socio-economic component of the NNS using principal
component analysis (PCA).
Body mass index (BMI) was computed and categorized
according to the WHO cut-off standards of 25.0–29.99 kg/
m2 to define overweight and > 30.00 kg/m2 to define obesity.
Selected lifestyle related factors covered in the study
include physical activity status, smoking status and
alcohol consumption status. Physical activity was
categorized into physically inactive and physically active
based on the WHO Steps Surveillance Manual (WHO
2005). Smoking status was categorized into three (3) –
current, former, and never – based on the WHO STEPS
Surveillance Manual. This includes individuals who
consumed commercial/ manufactured cigarettes, hand-
rolled cigarettes, pipes full of tobacco, cigars/cheroots,
and/or cigarillos. Alcohol consumption was likewise
categorized into three (3) – lifetime abstainer, former,
and current – based on the WHO Global status report on
alcohol and health (WHO 2014a).
Adequacy of dietary intake was evaluated using the
Philippine Dietary Reference Intake. An individual
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Philippine Journal of Science Duante et al.: Factors Associated with Overweight
Vol. 148 No. 1, March 2019 and Obesity among Adults: 2013 NNS

meeting 100% of recommended energy intake (REI) is Ethics

considered to have adequate energy intake, and those The 8th NNS was approved by the FNRI Institutional
meeting 100% of the estimated average requirement Ethics Review Committee (FIERC) on 19 Feb 2013, with
(EAR) for protein is considered to have adequate protein Protocol Code FIERC-2012-001. Consent was obtained in
intake. Intakes less than 100% of both REI and protein writing from respondents prior to actual data collection. The
EAR were considered inadequate. Informed Consent Form contained all the components of
the 8th NNS, detailed data collection procedures, and non-
disclosure of information for anonymity and confidentiality
Study Population and Subjects
purposes. The contents of the informed consent form are
The subjects of this study were Filipino adults 20.0 years
published elsewhere (DOST-FNRI 2015b).
and over. Upon data merging, a total of 9,076 adults
20.0 years and over had complete anthropometric, socio-
demographic, selected NCD-risk factor, and dietary
data. Subjects with incomplete data on aforementioned
components were dropped from the analysis.
RESULTS AND DISCUSSION

Results
Data Processing and Analysis
Sample characteristics. The socio-demographic and
Sampling weights were computed and adjusted for non-
socio-economic characteristics of overweight and obese
response and were post-stratified based on the projected
adults 20.0 years and over are presented in Table 1.
population obtained from the PSA. Weighted statistical
Overall, three out of 10 adults (30.0%) were overweight/
analyses were done using Stata Version 12.0 designed
obese. The proportion of overweight and obesity was
for complex analysis, taking into consideration the stages
higher among females (33.5%) than males (26.3%),
of household selection for participation in the survey.
among older age groups of 40–49.0 years (36.0%)
Descriptive statistics such as means, standard deviations,
and 50–59 years (36.6%) than younger groups, and
frequencies and percentages, and confidence intervals were
among those with partners (married and live-in) than
generated to describe the distribution of each variable.
those without (single, widow/ widower, and separated).
Multiple logistic regression was used for the determinants of
Overweight and obesity prevalence increased as
overweight and obesity among adults. Reliability of estimates
educational attainment improved.
for the odds ratio (OR) was set at 95% confidence interval.

Table 1. Socio-demographic and socio-economic characteristics of overweight and obese adults 20.0 years and over: Philippines, 2013 (n = 9,076).
Socio-Demographic Characteristics n % (95% CI)
Philippines 9,076 30.0 (28.4–31.6)
Sex
Male 4,490 26.3 (24.5–28.2)
Female 4,586 33.5 (31.7–35.4)
Age Group
20–29 y.o. 1,862 19.6 (17.2–22.3)
30–39 y.o. 1,667 32.8 (30.1–35.6)
40–49 y.o. 2,015 36.0 (33.7–38.3)
50–59 y.o. 1,793 36.6 (33.4–40.0)
60 y.o. and over 1,739 26.6 (23.9–29.5)
Civil Status
Single 1,798 22.5 (19.6–25.7)
Married 5,452 34.1 (32.5–35.7)
Live-in 773 27.4 (23.6–31.4)
Widow/Widower 838 28.3 (25.0–31.9)
Separated/Annulled/ Divorced 210 22.2 (16.6–29.0)

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Vol. 148 No. 1, March 2019 and Obesity among Adults: 2013 NNS

Cont. Table 1. Socio-demographic and socio-economic characteristics of overweight and obese adults 20.0 years and over: Philippines,
2013 (n = 9,076).
Socio-Demographic Characteristics n % (95% CI)
Highest Educational Attainment
No Grade Completed 258 16.3 (11.7–22.3)
Preschool/Elementary Level 3,169 23.0 (21.2–24.9)
High School/Vocational 3,679 30.6 (28.9–32.3)
College Level/Higher 1,970 38.4 (34.9–41.9)
Occupation
Special Occupations (AFP personnel, unclassified jobs) 57 33.3 (21.6–47.6)
Officials of Government and Special-Interest Organizations,
604 50.5 (45.9–55.0)
Corporate Executives, Managers Managing Proprietors and Supervisors
Professional 294 39.1 (32.3–46.4)
Technicians and Associate Professionals 194 38.7 (31.1–46.9)
Clerks 284 34.5 (28.1–41.4)
Service Workers And Shop and Market Sales Workers 433 36.9 (32.0–42.0)
Farmers, Forestry Workers and Fishermen 1,657 15.6 (13.9–17.4)
Craft and Related Trades Workers 457 21.7 (16.6–27.9)
Plant And Machine Operators and Assemblers 409 42.0 (36.9–47.3)
Elementary Occupation: Laborers and Unskilled Workers 1,033 28.0 (24.9–31.4)
No Occupation 3,654 29.1 (27.1–31.1)
Type of Residence
Rural 5,071 24.1 (22.6–25.6)
Urban 4,005 35.2 (32.8–37.7)
Region
Ilocos Region 591 26.9 (23.2–30.8)
Cagayan Valley 488 20.8 (16.7–25.4)
Central Luzon 761 30.4 (27.0–34.1)
Bicol 521 23.6 (19.0–29.0)
Western Visayas 658 19.9 (15.7–24.9)
Central Visayas 720 28.8 (25.1–32.7)
Eastern Visayas 494 30.4 (25.5–35.7)
Zamboanga Peninsula 343 24.9 (20.2–30.2)
Northern Mindanao 500 28.4 (23.7–33.7)
Davao 508 28.1 (25.2–31.1)
SOCCSKSARGEN 427 25.2 (21.4–29.6)
NCR 838 41.1 (35.7–46.8)
CAR 357 34.6 (27.2–43.0)
ARMM 275 20.0 (14.8–26.6)
Caraga 362 33.7 (30.2–37.3)
CALABARZON 866 33.7 (30.1–37.5)
MIMAROPA 367 23.6 (17.3–31.2)
Wealth Quintile
First Quintile (Poorest) 1,843 17.1 (14.5–20.0)
Second Quintile 1,908 24.3 (22.0–26.9)
Middle 1,924 26.3 (22.0–31.1)
Fourth Quintile 1,707 34.6 (32.0–37.4)
Fifth Quintile (Wealthiest) 1,694 43.7 (40.8–46.6)

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Vol. 148 No. 1, March 2019 and Obesity among Adults: 2013 NNS

Overweight and obesity was more prevalent among Table 2. Proportion of overweight and obese adults 20.0 years and
officials of government and special interest organizations, over by selected lifestyle-related risk factors: Philippines,
corporate executives, managers, managing proprietors, 2013 (n = 9,076).
and supervisors (50.5%) plus plant/ machine operators Selected Lifestyle-
n % (95% CI)
and assemblers (42.0%). Moreover, at least one-third of related Risk Factors
those who worked as professionals (39.1%), technicians, General Physical
and associate professionals (38.7%); service workers and Activity
shop/ market sales workers (36.9%); clerks (34.5%); and Physically Inactive1 3,896 31.1 (29.4–32.9)
those with special occupations (33.3%) were overweight/ Physically Active1 5,180 29.1 (26.7–31.7)
obese. Farmers, forestry workers, and fishermen only had  
15.6% prevalence. Smoking Status

More than one-third (35.2%) of urban dwellers, almost Never Smoker2a 5,130 33.4 (31.9–35.0)
one-fourth (24.1%) of rural dwellers, and at least one- Former Smoker2b 2,450 21.1 (18.6–23.8)
third of adults residing in the National Capital Region Current Smoker2c 1,496 32.9 (29.9–36.1)
(NCR) (41.1%), Cordillera Administrative Region (CAR)  
(34.8%), Caraga (33.7%), and CALABARZON (33.7%) Alcohol Status
were overweight/ obese. Lifetime Abstainer3a 3,351 31.0 (29.0–33.0)
Former Drinker3b 1,190 30.6 (27.7–33.7)
In terms of socio-economic status, overweight/ obesity
prevalence increased as wealth quintile improved – with Current Drinker3c 4,535 29.2 (27.3–31.1)
four out of 10 (43.7%) from the richest quintile being Notes:
1A person not meeting any of the following criteria is considered as physically
overweight/ obese. inactive or insufficiently physically active – 3 or more days of vigorous intensity
activity of at least 20 min/d; or 5 or more days of moderate intensity activity or
Selected lifestyle-related risk factors such as physical walking of at least 30 min/d
2aNever smokers – those individuals who have never smoked at all
activity, smoking status, and alcohol status were also 2bFormer smokers – those who have ever smoked in the past year prior to survey
studied. Results in Table 2 showed that overweight/ whether in a daily basis or an aggregate lifetime consumption of at least 100
obesity was prevalent at 31.1% in physically inactive and cigarettes but not daily
2cCurrent smokers – those who smoke during time of survey either on a daily
at 29.1% in physically active adults. One-third of never basis (at least one cigarette a day) or on a regular/ occasional smoking; those
smokers (33.4%) and current smokers (32.9%) plus only who do not smoke daily but who smoke at least weekly; or those who smoke
less often than weekly
one-fifth (21.1%) of former smokers were found to be 3aLifetime abstainers – those who have never consumed alcohol
3bFormer drinkers – those who have previously consumed alcohol, but have not
overweight/ obese. The prevalence of overweight/ obesity done so in the previous 12-mo period
among lifetime abstainers, former drinkers, and current 3cCurrent drinkers – those who were currently consuming alcohol during the

drinkers ranged 29.2–31.0%. survey period

Dietary intake was also accounted for (Table 3), which is

a crucial factor of the nutritional outcome. Mean energy
intake of overweight/ obese adults was 1,752.0 kcal. Mean
intake for macronutrients was 298.4 g of carbohydrate,
34.8 g of fat, and 58.9 g of protein. Average beverage
intake was 72.8 g.
Adequacy of energy and protein intake was also assessed
(Table 4). More than one-third of those meeting the 100%
recommended energy intake (REI) (35.5%) and estimated
average requirement (EAR) of 100% for protein (34.3%)
were overweight/ obese.

Table 3. Mean one-day per capita dietary intake of overweight or Table 4. Energy and protein adequacy of overweight or obese adults
obese adults 20 years and over: Philippines, 2013 (n = 20 years and over: Philippines 2013 (n = 9,076).
9,076). Adequacy of energy and
n % (95% CI)
Energy and 95% CI protein intake
Mean SE
Nutrients LL UL Meeting 100% energy
requirement
Energy (kcal) 1,752.0 17.1 1,718.3 1,785.6
No 6,494 28.5 (27.0–30.1)
Carbohydrate (g) 298.4 3.2 292.1 304.7
Yes 2,582 35.5 (32.8–38.4)
Fat (g) 34.8 0.8 33.2 36.4
Meeting 100% protein
Protein (g) 58.9 0.6 57.7 60.1 requirement
No 6,494 26.1 (24.4–27.9)
Yes 2,582 34.3 (32.3–36.4)

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Vol. 148 No. 1, March 2019 and Obesity among Adults: 2013 NNS

Factors associated with overweight and obesity.
Controlling for the effects of other variables, the factors
associated with overweight/ obesity among adults 20.0
years and over included adequacy of recommended
energy requirement, type of residence, age group, civil
status, wealth quintile, highest educational attainment,
and smoking status (Table 6). The results of the univariate
analysis are presented in Table 5.
Being overweight/ obese is 1.3 times more likely among
adults who meet the 100% REI than those who do not.
The odds of overweight/ obesity were higher among those
living in urban areas (OR: 1.28; CI: 1.09–1.50; p = 0.002)
than in rural areas.
The odds of being overweight/ obese increased as the age
group progressed up to the 50–59 age group. Compared to
the 20–29 age group, adults 30–39 years (OR: 2.05; CI:
1.66–2.53; p < 0.000), 40–49 years (OR: 2.51; CI: 2.03–
3.10; p < 0.000) and 50–59 years (OR: 2.51; CI: 2.03–3.09;
p < 0.000) were twice as likely to be overweight/ obese.
Those 60 years and over were 1.69 times more likely to
be overweight/ obese than the youngest adult age group.

Table 5. Univariate analysis of factors affecting overweight and obesity among adults, 20 years and over: Philippines, 2013 (n = 9,076).

Odds 95% CI
Factors SE t p-value F-statistic Prob > F
Ratio LL UL
Region 4.77 <0.001*
Constant 0.70 0.08 –3.06 0.002 0.56 0.88
Ilocos 0.53 0.08 –4.20 0.000 0.39 0.71
Cagayan Valley 0.37 0.07 –5.51 0.000 0.26 0.53
Central Luzon 0.63 0.09 –3.23 0.001 0.47 0.83
Bicol 0.44 0.08 –4.47 0.000 0.31 0.63
Western Visayas 0.36 0.07 –5.54 0.000 0.25 0.51
Central Visayas 0.58 0.09 –3.65 0.000 0.43 0.78
Eastern Visayas 0.62 0.11 –2.77 0.006 0.45 0.87
Zamboanga Peninsula 0.47 0.09 –4.16 0.000 0.33 0.67
Northern Mindanao 0.57 0.10 –3.30 0.001 0.41 0.80
Davao 0.56 0.08 –4.21 0.000 0.43 0.73
SOCCSKSARGEN 0.48 0.08 –4.52 0.000 0.35 0.66
NCR Reference
CAR 0.76 0.16 –1.30 0.196 0.50 1.15
ARMM 0.36 0.08 –4.64 0.000 0.23 0.55
Caraga 0.73 0.10 –2.25 0.025 0.55 0.96
CALABARZON 0.73 0.10 –2.20 0.028 0.55 0.97
MIMAROPA 0.44 0.10 –3.57 0.000 0.28 0.69
Type of Residence 59.19 <0.001*
Constant 0.32 0.01 –28.13 0.000 0.29 0.34
Rural Reference
Urban 1.72 0.12 7.69 0.000 1.49 1.97
Sex 50.95 <0.001*
Constant 0.36 0.02 –21.17 0.000 0.33 0.39
Male Reference
Female 1.41 0.07 7.14 0.000 1.28 1.55
Age Group 40.88 <0.001*
Constant 0.24 0.02 –17.30 0.000 0.21 0.29
20–29 y.o. Reference
30–39 y.o. 2.00 0.19 7.21 0.000 1.66 2.42

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Vol. 148 No. 1, March 2019 and Obesity among Adults: 2013 NNS

Cont. Table 5. Univariate analysis of factors affecting overweight and obesity among adults, 20 years and over: Philippines, 2013 (n = 9,076)

Odds 95% CI
Factors SE t p-value F-statistic Prob > F
Ratio LL UL
40–49 y.o. 2.30 0.21 8.98 0.000 1.92 2.77
50–59 y.o. 2.37 0.18 11.59 0.000 2.05 2.74
60 y.o. and over 1.49 0.14 4.21 0.000 1.24 1.79
Civil Status 13.08 <0.001*
Constant 0.29 0.03 –13.93 0.000 0.24 0.35
Single Reference
Married 1.78 0.15 6.87 0.000 1.51 2.09
Live-in 1.29 0.14 2.45 0.015 1.05 1.59
Widow/Widower 1.36 0.13 3.15 0.002 1.12 1.65
Separated/Annulled/Divorced 0.98 0.18 –0.13 0.897 0.68 1.40
Wealth Quintile 36.76 <0.001*
Constant 0.21 0.02 –16.20 0.000 0.17 0.25
First Quintile (Poorest) Reference
Second Quintile 1.56 0.17 4.05 0.000 1.26 1.94
Middle 1.73 0.27 3.57 0.000 1.28 2.34
Fourth Quintile 2.58 0.30 8.18 0.000 2.05 3.24
Fifth Quintile (Wealthiest) 3.77 0.46 10.86 0.000 2.96 4.79
Highest Educational Attainment 33.03 <0.001*
Constant 0.20 0.04 –8.38 0.000 0.13 0.29
No Grade Completed Reference
Preschool/Elementary Level 1.53 0.31 2.12 0.035 1.03 2.27
High School/Vocational 2.26 0.46 4.03 0.000 1.52 3.37
College Level/Higher 3.19 0.65 5.68 0.000 2.13 4.76
Meeting 100% Energy Requirement 28.37 <0.001*
Constant 0.40 0.02 –23.76 0.000 0.37 0.43
No Reference
Yes 1.38 0.08 5.33 0.000 1.23 1.56
Meeting 100% Protein Requirement 53.38 <0.001*
Constant 0.35 0.02 –22.55 0.000 0.32 0.39
No Reference
Yes 1.48 0.08 7.31 0.000 1.33 1.65
Total Energy Intake 17.91 <0.001*
Constant 0.33 0.02 –14.66 0.000 0.28 0.38
Total Energy Intake 1.00 0.00 4.23 0.000 1.00 1.00
Total Carbohydrate Intake 0.09 0.763
Constant 0.42 0.03 –12.02 0.000 0.37 0.48
Total Carbohydrate Intake 1.00 0.00 0.30 0.762 1.00 1.00
Total Fat Intake 64.25 <0.001*
Constant 0.32 0.02 –19.99 0.000 0.29 0.36
Total Fat Intake 1.01 0.00 8.02 0.000 1.01 1.01

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Philippine Journal of Science Duante et al.: Factors Associated with Overweight
Vol. 148 No. 1, March 2019 and Obesity among Adults: 2013 NNS

Cont. Table 5. Univariate analysis of factors affecting overweight and obesity among adults, 20 years and over: Philippines, 2013 (n = 9,076)

Odds 95% CI
Factors SE t p-value F-statistic Prob > F
Ratio LL UL
Total Beverage Intake 5.03 0.026*
Constant 0.42 0.02 –22.24 0.000 0.39 0.45
Total Beverage Intake 1.00 0.00 2.24 0.026 1.00 1.00
SSB Intake 11.5 0.0008*
Constant 0.40 0.02 –22.12 0.000 0.37 0.44
SSB Intake 1.00 0.00 3.39 0.001 1.00 1.00
General Physical Activity 1.59 0.208
Constant 0.41 0.03 –14.61 0.000 0.36 0.46
Physically Inactive 1.10 0.08 1.26 0.208 0.95 1.27
Physically Active Reference
Smoking Status 35.76 <0.001*
Constant 0.27 0.02 –16.82 0.000 0.23 0.31
Lifetime Abstainer 1.88 0.14 8.31 0.000 1.62 2.18
Former Smokers 1.84 0.17 6.71 0.000 1.54 2.19
Current Smokers Reference
Alcohol Status 1.62 0.199
Constant 0.41 0.02 –18.84 0.000 0.38 0.45
Lifetime Abstainer 1.09 0.05 1.74 0.083 0.99 1.20
Former Drinkers 1.07 0.08 0.90 0.371 0.92 1.25
Current Drinkers Reference
Occupation 27.35 <0.001
Constant 0.41 0.02 –18.03 0.000 0.37 0.45
Special Occupations 1.22 0.37 0.65 0.517 0.67 2.23
Officials of Government and Special-
Interest Organizations, Corporate
2.48 0.23 9.84 0.000 2.07 2.98
Executives, Managers, Managing
Proprietors, and Supervisors
Professional 1.57 0.22 3.16 0.002 1.18 2.07
Technicians and Associate Professionals 1.54 0.27 2.50 0.013 1.10 2.16
Clerks 1.28 0.22 1.45 0.147 0.92 1.79
Service Workers and Shop
1.42 0.17 2.98 0.003 1.13 1.80
and Market Sales Workers
Farmers, Forestry Workers, and
0.45 0.04 –10.11 0.000 0.39 0.53
Fishermen
Craft and Related Trades Workers 0.68 0.10 –2.53 0.012 0.50 0.92
Plant and Machine Operators, and
1.77 0.20 5.07 0.000 1.42 2.20
Assemblers
Elementary Occupation:
0.95 0.09 –0.58 0.560 0.80 1.13
Laborers and Unskilled Workers
No Occupation Reference

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Philippine Journal of Science Duante et al.: Factors Associated with Overweight
Vol. 148 No. 1, March 2019 and Obesity among Adults: 2013 NNS

Table 6. Multivariate analysis on overweight or obesity of adults 20 years and over by selected factors: Philippines, 2013 (n = 9,076).
Odds 95% CI
Factors SE t p-value
Ratio LL UL
Constant Term 0.04 0.01 –15.73 0.000 0.02 0.05
Meeting 100% Energy Requirement
No Reference
Yes 1.29 0.08 4.05 0.000 1.14 1.47
Type of Residence
Rural Reference
Urban 1.28 0.10 3.08 0.002 1.09 1.50
Age Group
20–29 y.o. Reference
30–39 y.o. 2.05 0.22 6.71 0.000 1.66 2.53
40–49 y.o. 2.51 0.27 8.49 0.000 2.03 3.10
50–59 y.o. 2.51 0.27 8.62 0.000 2.03 3.09
60 y.o. and over 1.69 0.20 4.39 0.000 1.34 2.14
Civil Status
Single Reference
Married 1.39 0.15 3.01 0.003 1.12 1.72
Live-in 1.35 0.16 2.48 0.014 1.06 1.72
Widow/Widower 1.19 0.15 1.32 0.186 0.92 1.53
Separated/Annulled/Divorced 0.78 0.15 –1.26 0.210 0.54 1.15
Unknown 0.52 0.60 –0.56 0.576 0.05 5.10
Wealth Quintile            
First Quintile (Poorest) Reference
Second Quintile 1.41 0.16 2.98 0.003 1.12 1.77
Middle 1.51 0.22 2.78 0.006 1.13 2.03
Fourth Quintile 2.08 0.27 5.67 0.000 1.61 2.69
Fifth Quintile (Wealthiest) 2.72 0.44 6.13 0.000 1.97 3.75
Highest Educational Attainment
No Grade Completed Reference
Preschool/Elementary Level 1.32 0.26 1.40 0.162 0.89 1.94
High School/Vocational 1.73 0.35 2.75 0.006 1.17 2.57
College Level/Higher 2.09 0.46 3.31 0.001 1.35 3.23
Smoking Status
Lifetime Abstainer 1.71 0.14 6.52 0.000 1.46 2.01
Former Smokers 1.54 0.14 4.66 0.000 1.28 1.85
Current Smokers Reference

Adults with partners were more likely to be overweight/
obese than those who were single. Married adults and
those with live-in partners had 39% and 35% higher odds
of becoming overweight/ obese than single adults.
In terms of socio-economic status, the odds of being
overweight/ obese increased as wealth improved. Those in
the rich (OR: 2.08; CI: 1.61–2.69; p < 0.000) and richest
quintiles (OR: 2.72; CI: 1.97–3.75; p < 0.000) were more
than twice more likely to be overweight/ obese compared
to adults in the poorest quintile.
The likelihood of being overweight/ obese increased
with educational attainment. In comparison with adults

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Philippine Journal of Science
Vol. 148 No. 1, March 2019
with no grade completed, the odds of being overweight/
obese was higher among those who were high school/
vocational graduates (OR: 1.73; CI: 1.17–2.57; p = 0.006)
and twice as high among college graduates (OR: 2.09; CI:
1.35–3.23; p = 0.001).
DISCUSSION
To the knowledge of the researchers, this is the first study in
the Philippines that investigated the factors associated with
overweight and obesity among adults using a nationally-
representative sample. Based on NNS results, there was
a 50% increase in the prevalence of overweight/ obesity
among adults 20.0 years in a span of 20 years – from 1993
to 2013. Along with this increase was a 3.9 percentage
point decrease in the prevalence of chronic energy
deficiency/ underweight among adults in the same time
period. This phenomenon coincides with the growth of the
Philippine economy brought about by rapid urbanization,
globalization, and technological advancements resulting to
nutritional and epidemiological transitions.
After adjusting for potential confounders, this study found
that overweight/ obesity is significantly associated with
energy adequacy, type of residence, age, civil status, wealth
quintile, educational attainment, and smoking status.
Adults who met 100% of energy requirement were found
to have higher odds of being overweight/ obese. This may
be explained by the concept of positive energy balance
wherein weight gain is brought about greater energy
intake than energy expenditure, thus resulting to a higher
likelihood for overweight/ obesity.
Consistent with other studies, the odds of being
overweight/ obese was higher among adults who
were urban dwellers than those in rural areas (Little
et al. 2016, Hong et al. 2018). This may be due to the
attributes of the food and physical environment, which
promotes a generally unhealthy lifestyle of increased
consumption of energy-rich but nutrient-poor diets and
a sedentary lifestyle (Mkuu et al. 2018). Reliance on
technology for convenience and accomplish a variety of
tasks – from grocery shopping to cooking and spending
leisure time – has enabled a lifestyle that replaced actual
physical activity with accomplishing most tasks with
just the click of a button while in the comfort of any
place, any time.
The likelihood of being overweight/ obese as age group
increases may be explained by metabolic changes which
tend to slow as a person ages (Hong et al. 2018). As
pointed out by Hajek et al. (2015), ageing is accompanied
with changes in body composition, height, food intake and
energy expenditure. Decreased muscle mass and height
Duante et al.: Factors Associated with Overweight
and Obesity among Adults: 2013 NNS
associated with ageing may reduce physical activity and
energy expenditure (Hajek et al. 2015).
Another significant factor associated with adult
overweight/ obesity is civil status or marital status.
Similar with other studies, the odds of being overweight/
obese was noticeably higher among those married or
living with a partner (Mkuu et al. 2018, Hong et
al. 2018, Sobal et al. 2012, Tzotzas et al. 2010).
Wang et al. (2016) surmised that marital status
is associated with body weight changes, wherein
transition into marriage and transition into singlehood
were associated with weight gain and weight loss,
respectively. Moreover, Teachman (2016) provided
perspectives for this phenomenon anchored on social
and economic variables, perception of attractiveness,
and negative stress such as marital disruption. Married
individuals were more likely to have another person
to eat with, which may make them eat more regularly,
causing weight gain. It was also supposed that married
individuals care less about their physical attractiveness
in terms of body weight because, unlike single people,
they are not actively seeking a mate.
The premise of overweight/ obesity more common
among the more affluent is conflicting, as researches
have shown that overweight/ obesity is primarily a
problem of the rich in developing countries while the
burden of overweight/ obesity in developed countries
has shifted to the poor (HU-CSPH 2010). In the same
article, it was indicated that a 25% increase on wealth
index was associated with a 54% BMI increase and
a 33% overweight increase. Interestingly, in studies
among women (Hong et al. 2018, Little et al. 2016,
Bishwajit 2017), those who belonged to higher income
groups had animal-rich diets than lower-income
women. It was also highly likely that lower-income
women tend to do more physical labor than their more
affluent counterparts. Consumption behaviors among
high income women (Mkuu et al. 2018) – which is
also primarily driven by the environment an individual
is in – showed that they are more likely to consume
high-caloric foods, which increases the risk of being
overweight/ obese.
Those with higher educational attainment had higher
odds of becoming overweight/ obese compared to those
with lower education attainments. These individuals were
more likely to reside in urban areas for employment, to
have more resources because of job opportunity, and to
be immersed in a food and physical environment that
perpetuates an unhealthy lifestyle. These results were
found to be in agreement with other studies wherein
those who had secondary education or higher were more
likely to be overweight/ obese (Hong et al. 2018, Mkuu
et al. 2018).
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Philippine Journal of Science
Vol. 148 No. 1, March 2019
Lifetime abstainers and former smokers were more likely
to be overweight/ obese than current smokers, parallel
with other studies (Watanabe et al. 2016). This might be
explained by previous reports that tobacco use may be
associated with disruptions in digestive and absorptive
functions of the gastrointestinal system (Dare et al. 2015),
increasing energy expenditure, and suppressing appetite
(Wang et al. 2016). In a research among younger people,
smoking was used as a method to control weight.
CONCLUSION
This study reports a gradual increase in the prevalence
of overweight/ obesity among adults 20.0 years and over
in the Philippines. The approximately 50% increase in
the prevalence of overweight/ obesity versus the 3.9
percentage point decrease in the prevalence of chronic
energy deficiency (CED)/ underweight in a span of 20
years is reflective of a dire situation the country faces.
Not only does the persistent problem of undernutrition
exist, but also overweight/ obesity emerging as a
public health problem. The factors associated with
overweight/ obesity identified in this study were found
to be consistent with the results of other bodies of work.
It is particularly notable that higher educational status,
higher socioeconomic status, and residence in urban
areas pose an increased likelihood of being overweight/
obese. Along with the other factors found to be associated
with overweight obesity – age, energy adequacy, civil
status, and smoking status – it can be surmised that
overweight/ obesity as a public health concern is driven
by a multitude of factors that can be addressed using
a multi-sectoral approach. That being said, it is also
deemed as a challenge for public policy makers and
program and intervention formulators to balance the
resources and plan for efficient programs to address both
undernutrition among the poor and overweight/ obesity
among the more affluent and for the attainment of the
WHO Global NCD Targets of 2025 and SDG 3.
ACKNOWLEDGMENTS
The authors would like to acknowledge the contribution
of Ms. Ma. Lilibeth P. Dasco and Dr. Marina B. Vargas
for clearance of data for the survey’s anthropometric
and dietary components, respectively; and Ms. Apple
Joy D. Ducay for additional statistical analysis done
for this study.
18
Duante et al.: Factors Associated with Overweight
and Obesity among Adults: 2013 NNS
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